In various arthroscopic procedures, for instance reattachment of a rotator-cuff tendon, it is necessary to attach a suture to an internal body part and then to secure this suture to another part. For instance a suture is passed through a detached tendon and is then secured to a hole or anchor in a bone.
To minimize trauma, this surgery is conducted arthro-scopically or laparascopically, that is through a small hole in the patients skin. The tool that attaches the suture must therefore be of narrow dimensions so that it can be inserted through the access hole.
A typical device as described in U.S. Pat. No. 5,522,820 of Caspari has a pair of jaws, one of which is movable. A piercing needle with a hook end is fixed to one of the jaws and the other jaw is set up to hold a suture filament so that when the two jaws are moved together the needle pierces the body part between them and the suture is picked up by the hook end of the needle and pulled back through the part as the jaws are again separated In use the jaws are opened and then positioned to opposite sides of the tendon or other body part to be sutured, then they are pressed together so that the needle pierces this part. When the jaws are again opened, the needle pulls out of the hole it has made and draws the suture filament back through it.
The disadvantage of this system is that it is relatively thick, requiring a hole some 12 mm across to fit through In addition when open it is some 18 mm to 20 mm wide, so that it stretches out the body region where it is being employed and cannot be fit into tight locations. Furthermore it is relatively difficult to position it so that it pierces the body part just where desired, especially if, for instance, the part is a retracted tendon.
German patent document 2,447,719 of Schweizer describes another such system that basically operates like a pair of forceps that is closed on the part to be sutures so that it first clamps this part, then automatically pierces it and threads a suture through it. This device is relatively bulky and not suitable for arthroscopic work. Furthermore it must be perfectly positioned before being closed, as once it is closed on the part the needle is automatically advanced.